Prescribing Trends in a Glaucoma Clinic and Adherence to EGS Guidelines: A Retrospective, Non-Interventional, Single-Center UK Study
The purpose of this study was to determine prescribing trends in a specialist glaucoma clinic in the UK. Specifically, the aims were to determine which drugs were prescribed as first-, second-, and third-line treatment, the persistence of first-, second-, and third-line treatment regimens, and the proportion of treatment decisions conforming to the European Glaucoma Society (EGS) guidelines.
A retrospective, non-interventional, single-center, case-note review was performed on a cohort of consecutive patients presenting to a specialist glaucoma clinic for follow-up. Inclusion criteria for the study were (1) a diagnosis of primary open-angle glaucoma or ocular hypertension, (2) glaucoma management entirely within the unit, and (3) minimum of 2 years of follow-up.
A total of 114 case notes met the inclusion criteria. Mean age was 71 years (range 40–95 years). Mean length of follow-up was 56 months (range 24–180 months). Prostaglandin analogues (PGA) were the most popular first-line treatment in 73% of patients. As second-line treatment, PGA were again the predominant class, prescribed in 87% of cases, whereas beta-blockers (BB) were prescribed in 70% of cases. Carbonic anhydrase inhibitors (CAI) and alpha-2 agonists (AA) were more popular in third-line regimens. Second-line treatment was introduced at a mean of 28.0 months after first-line treatment (range 1–120 months, 95% CI 22.1–33.9 months). Third-line treatment was introduced at a mean of 22.9 months after second-line treatment (range 1–96 months, 95% CI 17.1–28.8 months). Breaches to EGS guidelines were most common for third-line treatment and included duplication of drug classes.
There was a clear hierarchy of PGA as first-line, BB as second-line, while CAI and AA were considered third-line choices. First-line choices were generally in line with EGS guidelines. There was a tendency to breach guidelines by escalating treatment in dual steps rather than single steps (especially in third-line treatment). Combination drops were popular. In third-line treatment there was an increased incidence of prescribing errors. This data is important in terms of informing patients of the expected treatment course, to remind clinicians about best practice, and also to guide comparisons of cost-effectiveness with other treatment modalities.
KeywordsAdherence Alpha 2 agonists Beta blockers Carbonic anhydrase inhibitors EGS guidelines Glaucoma Ocular hypertension Ophthalmology Prostaglandins
No funding or sponsorship was received for this study or publication of this article. The article processing charges were funded by the authors. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. Glaucoma: Diagnosis and Management. Clinical Guideline (CG85). April 2009 https://www.nice.org.uk/guidance/cg85.
Mark Fajgenbaum and Ejaz Ansari have no disclosures.
Compliance with Ethics Guidelines
The study was approved by a local audit and ethics committee and adhered to the tenets of the Declaration of Helsinki of 1964, as revised in 2013.
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